Authors' response
Editor — As the authors of ‘Equine influenza: a current reference for vets in practice in the UK’, published in the September/October 2019 issue of UK-Vet Equine, we are grateful to Dr Lees for raising concerns that The Boehringer Ingelheim technical team had with inconsistencies between the advice given in the article and the Summaries of Product Characteristics (SPC) for their vaccines ProteqFlu and ProteqFluTe. We are also grateful to Professor Durham for the benefit of his experiences and for his provision of data from the VMD
It is not uncommon for current best evidence or expert opinion to conflict with the recommendations made in SPCs as the latter are updated infrequently and are often superseded by published evidence (Hardefeldt, 2019). It is however important that vets are aware when they are using medicines ‘off label’, and the authors therefore welcome the points of clarification relating to the SPCs for ProteqFlu that Ms Lees has raised.
Considering more carefully the SPC for ProteqFlu/ProteqFluTe in response to Ms Lees comments, and taking account of published evidence highlighting reduction in immunity that may result from using ProteqFlu in young foals (Fougerolle et al, 2016), we feel able to offer more generic advice that all vaccines can be used from 4–5 months of age in the face of increased risk. However, an early vaccine should not replace the primary course of vaccination which should commence at 56 months irrespective of whether vaccines have been administered at a younger age.
Ms Lees second concern relates to the statement in the article: ‘There is a perception among UK practitioners that reactions are more common with the canarypox vector; however, this has not been substantiated’. Ms Lees expresses concern that this statement ‘has the potential to be misinterpreted by veterinary surgeons’. We are confident that veterinary surgeons will be able to understand that there is no robust evidence to confirm or refute whether there is a higher rate of reactions with Proteq/ProteqFlu than with other vaccine brands. Our collective, but anecdotal, experiences are consistent with the views of practitioners, hence we assigned colour amber to ProteqFlu in the vaccine reactions column of Table 2. Endorsing our view, Ms Lees highlights the lack of evidence regarding vaccine reactions. We would welcome research into the rate of vaccination reactions because the perception among owners that there are risks associated with influenza vaccination is a major impediment to increasing vaccination rates and protecting the national herd against equine influenza.
Yours faithfully,
Mark Bowen
Philip Ivens
Hattie Lawrence
Celia Marr
Richard Newton
Romain Paillot
Adam Rash
David Rendle